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Cytomegalovirus seroprevalence in pregnant women in Madrid: First step for a systematic screening
Seroprevalencia de citomegalovirus en mujeres embarazadas en Madrid: primer paso para un cribado sistemático
María de la Callea, Paula Rodríguez-Molinob,
Corresponding author
paularmolino@gmail.com

Corresponding author.
, M. Pilar Romero Gómezc, Fernando Baquero-Artigaod
a Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Madrid, Spain
b Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Madrid, Spain
c Servicio de Microbiología, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, CIBER Enfermedades Infecciosas (ISCIII), Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cytomegalovirus &#40;CMV&#41; infection is the most common congenital infection in the industrialised countries&#46; A worldwide prevalence of 0&#46;67&#37; is estimated&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> although these values vary depending on the country&#44; which is 0&#46;48&#37; in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Congenital CMV produces high morbidity and mortality&#59; 20&#37; of symptomatic newborns develop sensorineural hearing loss and psychomotor retardation and 4&#37; die&#46; In addition&#44; 13&#37; of asymptomatic newborns develop long-term sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite the fact that serological screening during pregnancy is not recommended in Spain&#44; in recent years certain diagnostic and therapeutic innovations have reopened this debate&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The worldwide prevalence of CMV in women of childbearing age is around 86&#37; and increases with age&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> These figures are higher than those of syphilis&#44; human immunodeficiency virus infection or hepatitis B virus&#46; In Spain there are no current data on the prevalence of CMV in pregnant women&#44; so we proposed this study to ascertain seroprevalence in pregnant women in our health area in Madrid&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A retrospective observational study was carried out between 2018 and 2019 including pregnant women with CMV serology in the first trimester&#46; An IgG avidity study was performed in IgG- and IgM-positive women&#44; whereas those with low avidity &#40;&#60;50&#37;&#41; underwent diagnostic amniocentesis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Architect &#40;Abbott&#41; CMIA &#40;Chemiluminescent Microparticle Enzyme Immunoassay&#41; reagents were used to perform CMV IgG&#44; CMV IgM and avidity testing&#46; The CMV quantitative PCR was performed in STARlet &#40;Werfen&#41; with the Altona RealStar&#174; CMV PCR Kit 1&#46;0 reagent&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of the 10&#44;431 pregnant women seen during this period&#44; IgG antibodies were determined in 6&#44;299 &#40;60&#46;39&#37;&#41; of them&#44; 3&#44;921 of which were positive&#44; which represents a seroprevalence of 62&#46;2&#37;&#46; Simultaneous determination of IgM was performed in 2&#44;721 pregnant women&#44; 237 &#40;8&#46;71&#37;&#41; of whom tested positive &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Of the pregnant women with positive IgM antibodies&#44; 37 &#40;15&#46;6&#37;&#41; had low IgG avidity&#44; suggesting an infection in the previous 3&#8211;6 months&#46; This indicates that 1&#46;35&#37; of women screened for IgM and IgG antibodies were at risk of gestational infection in the first trimester&#46; Of the 37 amniocenteses performed&#44; 12 &#40;32&#46;43&#37;&#41; had a positive PCR for CMV in amniotic fluid&#44; indicative of foetal infection and confirmed with PCR in urine at birth&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Therefore&#44; we can conclude that among pregnant women who have undergone serological screening using IgM and IgG&#44; the rate of congenital CMV in our area is 0&#46;44&#37;&#46; If we only take pregnant women with positive IgG and IgM antibodies into account&#44; this percentage rises to 5&#37;&#44; and is 32&#37; in the case of low IgG antibody avidity&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This study analyses the seroprevalence of CMV in pregnant women in our country&#44; with data that could be extrapolated to other populations with similar characteristics&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our setting&#44; 62&#37; of pregnant women are seropositive&#44; and more than one third are susceptible to suffering from a primary infection during pregnancy&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">1&#46;3&#37; of women with positive IgM and IgG had a result indicative of infection in the previous three to six months and 32&#37; of them developed a congenital infection&#46; The global burden of congenital infection in our setting is surely higher&#44; since infections produced after the first trimester and reinfections&#47;reactivations in immune women have not been considered&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">New therapeutic options are currently being tested in pregnant women to prevent foetal infection&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Thus&#44; a randomised&#44; placebo-controlled clinical trial shows a significant decrease in foetal infection rates in pregnant women infected in the first trimester who received treatment with valacyclovir &#40;11&#37; vs&#46; 48&#37;&#59; p&#160;&#61;&#160;0&#46;020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In addition&#44; different groups have studied the role of hyperimmune gamma-globulin&#44; and although there are questions about its efficacy&#44; one study demonstrates a benefit in the transmission of infection to the foetus using high fortnightly doses &#40;7&#46;5&#37; vs&#46; 35&#46;2&#37; in the historical control group&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">However&#44; it should be noted that knowledge of the serological status only provides useful information for detecting and treating primary CMV infections in pregnant women&#46; For this reason&#44; an effort must be made to improve serological techniques for the diagnosis of reinfections&#47;reactivations&#44; since they can also cause serious disease in the foetus&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Additionally&#44; serological screening in the first trimester would allow us to remind patients of the primary prevention recommendations&#44; which should be issued to all pregnant women at their first visit&#44; regardless of their serological status&#44; given the possibility of primary infections and reinfections&#46; Finally&#44; it would make it possible to detect congenital infections with a risk of long-term sequelae&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> guaranteeing an adequate follow-up of infected children&#46;</p></span>"
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